Final exam

There are no “right” or “wrong” answers. The more specific detail and pertinent examples you provide, the more credit you stand to earn. You will be graded on the overall thoughtfulness and thoroughness of your papers; see page 3 of this exam for the criteria I use in grading responses to essay questions. Do not restrict yourself to answers or viewpoints found in your textbook, PowerPoints, class notes, and resource articles; your own creative reflection, bringing together what you have learned from various sources, will be a big plus. In formulating your responses, you may use whatever resources you wish—but be sure to credit your sources for any quotes or borrowed ideas. In most cases, responses of adequate depth will require something around at least one double-spaced page per question.

1. What do Bruce Link and Jo Phelan mean when they argue that individually based risk factors must be contextualized? Give a specific and detailed case example (which may be either actual or hypothetical) of how someone’s location in society (gender, race/ethnicity, socioeconomic status, etc.) places him or her at greater risk of some particular disease outcome. What kind of intervention(s) would you recommend to reduce the risk—and why?

Resource article:

Link, Bruce G., and Jo Phelan. 1995. “Social Conditions as Fundamental Causes ofDisease.” Journal of Health and Social Behavior 35(Extra Issue):80–94.

2. Suppose that you were in a position to allocate funding aimed at reducing health disparities in the city of Houston. What would you prioritize as (1) the single most effective short-term intervention (addressing critical needs in the next two years or so), and (2) the single most effective long-term intervention (targeted toward producing equity in health outcomes over the next twenty to thirty years)? Explain your answer.

Resources for reference:

Houston Department of Health and Human Services. 2008. “The City of Houston Health Disparities Data Report: March 2008.” Houston, TX: City of Houston. Retrieved October 31, 2018 (http://www.houstontx.gov/health/disparity.pdf).

“Houston State of Health: Informing Action with Health Data.” Retrieved October 31, 2018 (http://www.houstonstateofhealth.com/).

“Mayor Sylvester Turner Transition Committee on Public Health.” Retrieved October 31, 2018 (https://houstontx.gov/mayor/transitionreports/public_health.pdf).

3. What do you believe might make a person with activity limitations more likely—or less likely—than his or her nondisabled counterpart to receive a diagnosis of mental disorder, or to abuse alcohol or drugs—and why? Give a real or hypothetical case example.

Resources for reference:

Toombs, S. Kay. 1995. “The Lived Experience of Disability.” Human Studies18(1):9–23.

Turner, R. Jay, Donald A. Lloyd, and John Taylor. 2006. “Physical Disability and Mental Health: An Epidemiology of Psychiatric and Substance Disorders.” Rehabilitation Psychology 51(3):214–23.

4. In his presentation “Red Kool-Aid, Blue Kool-Aid,” Dr. Leonard A. Zwelling poses the following questions: “Is health care like the police, the fire department, the right to vote and the services of the military (as in all other democracies)? OR . . . Is health care like pork bellies, wheat futures, toilet paper and Gucci loafers (as in the U.S. today)? And when will we have this discussion . . . ?”

Do YOU believe health care in this country should be structured more like (1) a public utility or right of citizenship, or like (2) a commodity to be purchased on demand (as in the traditional fee-for-service arrangement)? Explain your answer, taking into account both the inherent strengths and weaknesses of your position and any significant barriers to its implementation.

Resource presentation:

Zwelling, Leonard A. 2018. “Red Kool-Aid, Blue Kool-Aid: How Partisan Politics and Greed Undermined the Value of ObamaCare” [PPT slides]. Presented at the Fall 2018 Health Disparities course, “Disparities in Health in America: Working Towards Social Justice” (SOS 3313, CRN 12796). (Available on Blackboard Learn under “Handouts & Powerpoints” for Week 9.)

5. Briefly summarize the history of the Tuskegee Syphilis Study, noting key points at which decisions were made that, in retrospect, stand out as ethical violations in the treatment of human research participants. Explain how the memory of such decisions continues to fuel mistrust of powerful medical and public health institutions. What kinds of measures, if any, do you believe might help overcome this mistrust? How, and under what conditions?

Resources for reference:

Thomas, Stephen B., and Sandra Crouse Quinn. 1991. “The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community.” American Journal of Public Health 81(11):1498–1505.

Gamble, Vanessa Northington. 1997. “Under the Shadow of Tuskegee: African Americans and Health Care.” American Journal of Public Health 87(11):1773–78.

6. What role has doctors’ professional dominance historically played in creating ethical problems in medical care? What role does bioethics, as institutionalized in today’s American health care system, actually play in limiting doctors’ professional dominance? (Hint: Think and write about what professional dominance entails, and how doctors’ position within the hierarchy of the health care community—as well as within society at large—has influenced the kinds of decisions they have been allowed or even expected to make.)

Resource for reference:

Annas, George J. 1991. “Ethics Committees: From Ethical Comfort to Ethical Cover.”Hastings Center Report 21(3):18–21.

Grading Criteria for Essay Questions

What I look for in responses to essay questions (such as in Makeup/Replacement Exams or Final Exams) is considerably more than just a summary of what was presented in class or in the textbook. A response that does THIS reasonably well will start out earning 3 credit points—to be either REDUCED (for misinformation or confusion) or AUGMENTED (for evidence that you are actively engaging with the class material and MAKING IT YOUR OWN).

The very best responses (worthy of a full 5 points credit per question) will accomplish the following:

1.Address ALL ASPECTS or parts of the question (or set of questions);

2.Bring up (and either support or refute) as many pertinent viewpoints (e.g., perspectives on controversial issues) as possible, so as to demonstrate broad comprehension of the material; and

3.Perhaps most importantly, provide SPECIFIC and DETAILED true (or at least true-to-life hypothetical) stories to illustrate and “flesh out” your points—showing how the concepts you have been studying apply to people’s real day-to-day life experiences.

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